Treatment

What treatments do people receive?

Around 220,000 closed treatment episodes were provided to clients for either their own or someone else’s drug use.

Many types of treatment are available in Australia to assist people experiencing problematic drug use, most of which aim to reduce the harm of drug use through services such as counselling or information and education. Additionally, some treatments use abstinence-oriented interventions in structured, drug-free settings to help prevent relapse and assist clients in developing skills to facilitate substance-free lifestyles.

In 2018–19, a total of 219,933 closed treatment episodes were provided to clients for their own or someone else’s drug use, with clients receiving an average of 1.6 closed treatment episodes nationally. The number of treatment episodes has increased by 51% since 2009–10 (from 145,630) and 5% from the previous year (208,935 in 2017–18).

Treatment types

Counselling continues to be the most common main treatment type provided to all clients, comprising almost 2 in 5 (39%) of all closed treatment episodes.

In 2018–19, counselling continued to be the most common main treatment type provided to all clients, comprising almost 2 in 5 (39%) of all closed treatment episodes. Assessment only was the second most common main treatment type (19%), followed by support and case management only (12%) and withdrawal management (11%). Among those clients who sought support for someone else’s drug use, 52% received counselling as their main treatment, down from 70% in 2017–18.

Counselling was the most common main treatment type for all clients in most jurisdictions, including Western Australia (69% of closed treatment episodes), Tasmania (48%), New South Wales (39%), Queensland (36%), and Victoria (33%). By comparison, assessment only was the most common main treatment type in the Northern Territory (38% of closed treatment episodes) and South Australia (36%), while information and education only was the most common main treatment in the Australian Capital Territory (29%). Jurisdictional variation in main treatment type may reflect differences in service provision between states and territories. For example, police drug diversion referrals in South Australia may have contributed to the relatively large proportion of assessment only treatment episodes compared with other jurisdictions.

Nationally since 2009–10, the proportion of closed treatment episodes for the four most common main treatment types has changed. For example, support and case management only increased from 9% of all closed treatment episodes to 12% in 2018–19, while assessment only rose from 14% to 19% in the same period. By contrast, withdrawal management fell from 17% to 11%, while counselling declined slightly from 42% to 39%. However, proportions of closed treatment episodes for each main treatment type have fluctuated over the past 10 years from 2009–10.

Treatment delivery setting

Most closed treatment episodes were provided in a non-residential treatment facility setting (65%).

Nationally, most closed treatment episodes were provided in a non-residential treatment facility setting (65%), such as community-based NGOs and hospital outpatient services, followed by residential treatment facilities, which allow clients to dwell in a facility that is not their home or usual place of residence, and outreach settings (both 15% of closed treatment episodes).

Among clients seeking treatment for their own drug use, non-residential treatment facilities were the most common delivery setting for treatment episodes where the PDOC was heroin (69%), cannabis (68%), amphetamines (63%) or alcohol (62%). The second most common treatment setting was residential treatment facilities among clients with heroin (17%), alcohol (18%) or amphetamines (16%) as the PDOC, and outreach settings for clients with cannabis (18%) as the PDOC.

Across all treatment episodes, counselling was the most common main treatment type for treatments delivered in a non-residential facility (50%) or outreach setting (29%). Withdrawal management was the most common main treatment type in residential settings, used in nearly half (47%) of all treatment episodes for a client’s own drug use.

Length of treatment

The median treatment duration was longest for clients with a principal drug of concern of amphetamines (28 days).

In 2018–19, the median treatment duration across all treatment episodes was just over 3 weeks (23 days), slightly longer from 2017–18 (20 days). Among clients seeking treatment for their own drug use, the median treatment duration was also 23 days, up from 19 days in 2017–18. Median treatment duration for clients receiving support for someone else’s drug use was 14 days, a 55% decrease from 2017–18 (31 days). Around 4 in 5 closed treatment episodes ended within 3 months for clients receiving treatment for their own (79%) or someone else’s drug use (80%).

The duration of closed treatment episodes varied by main treatment type and principal drug of concern. Among all clients, the median duration of closed treatment episodes was 63 days for clients receiving counselling, 42 days for rehabilitation, 38 days for support and case management only, 8 days for withdrawal management, and 1 day for assessment only.

Among the four most common principal drugs of concern, median treatment duration was longest for amphetamines (28 days), followed by alcohol (26 days), heroin (19 days), and cannabis (17 days). Since 2009–10, the median duration of heroin treatment episodes fell from 34 days to 19 days.

Closed treatment episodes for amphetamines (28 days) and alcohol (26 days) were longer than for heroin (19 days) in 2018–19. This represents a reversal of trends in the 10 years prior to 2017–18, when treatment episodes for clients with heroin as their PDOC tended to be longer than for alcohol, amphetamines, and cannabis.

Reasons for cessation

In 2018–19, over half (61%) of closed treatment episodes for a client’s own drug use were expected/planned completions, with a further 7% ending due to the clients being referred to another service or changing their treatment mode. However, around 1 in 5 (21%) closed treatment episodes ended due to an unplanned completion. These figures have remained relatively constant over the 10 years from 2009–10.

Consistent with 2017–18, the highest proportion of expected/planned treatment episode completions occurred where ecstasy was the PDOC (83% of closed treatment episodes). The highest proportion of closed treatment episodes with an unplanned completion occurred where amphetamines were the PDOC (27% of treatment episodes).